Provider Demographics
NPI:1841308418
Name:SAGE PHYSICIAN PARTNERS, INC
Entity type:Organization
Organization Name:SAGE PHYSICIAN PARTNERS, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:D
Authorized Official - Middle Name:YALE
Authorized Official - Last Name:SAGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-754-8700
Mailing Address - Street 1:3100 MCKINNON STREET
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201
Mailing Address - Country:US
Mailing Address - Phone:214-754-8700
Mailing Address - Fax:469-893-1938
Practice Address - Street 1:1452 HUGHES RD
Practice Address - Street 2:SUITE 200
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051
Practice Address - Country:US
Practice Address - Phone:817-410-5721
Practice Address - Fax:469-893-1938
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAGE PHYSICIAN PARTNERS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-25
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00X078Medicare PIN